患者对维持生命治疗的决策偏好的误解
Anca-Cristina Sterie1, Gilles Merminod2, Eve Rubli Truchard3
1Chair of geriatric palliative care, Service of Palliative and Supportive care and Service of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Chair of Palliative Psychology, Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
患者在决定维持生命治疗 (LST) 时使用模两可,表达两个偏好. 医生经常错过这些细微的反应,可能会错误地记录患者的愿望并影响理解.
科学领域:
- 医学沟通 医学沟通
- 对话分析 对话分析
- 生物伦理学生物伦理学
背景情况:
- 有效的沟通对于医疗保健的共同决策至关重要.
- 患者对维持生命治疗 (LST) 的偏好需要仔细阐述和理解.
- 患者反应中的"误解"现象需要进一步研究.
研究的目的:
- 分析患者在允许或拒绝维持生命治疗时如何制定决策偏好.
- 调查"误解"的做法,患者在响应单一请求时表达双重偏好.
- 了解在重症监护环境中患者决策的细微差别.
主要方法:
- 对89次记录的患者与医生的互动进行了对话分析.
- 专注于患者讨论允许或拒绝维持生命治疗 (LST) 的对话.
- 患者偏好表达格式的分类.
主要成果:
- 确定了三种类型的决策偏好格式:明确的,隐含的模糊的和明确的模糊的.
- 毫不含糊的偏好表明一个干预的明确立场支持或反对干预.
- 模两可的偏好涉及有条件的陈述或两个对比的选项的表达.
结论:
- 关于LST的患者沟通是复杂的,并且取决于场景,经常偏离二进制医生请求.
- 医生可能并不总是识别或承认患者的模两可的反应.
- 对患者偏好的不充分记录可能是由于未被承认的模两可,影响患者的理解和识字能力.
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